Organ Transplant

Topic Overview

What is an organ transplant?

An organ transplant replaces a failing organ with a healthy organ from another person. Organs most often transplanted are:

• Kidney.
• Liver.
• Heart.
• Pancreas.
• Lung.
• Small intestine.

More than one organ can be transplanted at one time. For example, a heart and lung transplant is possible.

Who can get a transplant?

Not everyone is a good candidate for an organ transplant. Your doctor or a transplant center will do tests to see if you are. You probably are not a good candidate if you have an infection, heart disease that is not under control, a drug or alcohol problem, or another serious health problem.

If your tests show you are a good candidate, you are put on a waiting list.

How successful are organ transplants?

Transplants are more successful today than ever before. Organ transplant success depends on:

• Which organ is transplanted.
• How many organs are transplanted. For example, you could have a heart transplant or a heart and lung transplant.
• The disease that has caused your organ to fail.

How do you prepare for an organ transplant?

First, you'll need to have blood and tissue tests done that will be used to match you with a donor.

You'll also need to take care of your health. Continue to take your medicines as prescribed and get regular blood tests. Follow your doctor's directions for eating and exercising. You also may want to talk with a psychiatrist, psychologist, or licensed mental health counselor about your transplant.

To learn more about what happens, talk to someone who has had a transplant. Your transplant center or doctor can give you the name of someone who is willing to share his or her experience with you.

You may have to wait days, months, or years for your transplant. Be patient, and ask your doctor what you can do while you're waiting.

What can you expect afterward?

After a transplant, many people say they feel better than they have in years. What you can and can't do will depend on the type of transplant you had, other health problems you have, and how your body reacts to the new organ.

You will have to take daily medicines to prevent your immune system from rejecting the new organ. You will need less of these medicines as time goes by. Because these medicines weaken your immune system, you may have to stay away from large crowds for a while and stay away from people who have infections.

You will also have regular checkups and blood tests to see how well your new organ is working.

Depression is common after an organ transplant. If you think you may be depressed, get help. The earlier depression is treated, the more quickly you will feel better.

You may need to make some lifestyle changes to keep your new organ healthy and strong. This can include eating healthy foods, getting regular exercise, and getting enough sleep.

Who can be an organ donor?

Most people can be organ donors. If you are interested in donating an organ, contact the United Network for Organ Sharing (UNOS) at 1-888-894-6361 or go online at www.unos.org to get more information and to locate the nearest transplant center.

Many people choose to donate an organ upon their death. But a person can donate certain organs while he or she is still living. These people are called "living donors."

Learning About Transplants

How do you get on the waiting list?

Receiving a donor organ is a big responsibility. To get on the waiting list, you'll have to be committed to taking good care of yourself. The best way to do this is to take medicines as prescribed, get regular blood tests, and make any necessary lifestyle changes to stay healthy.

To get on the waiting list, you will need to:

• Obtain a referral from your doctor.
• Call the transplant center where you choose to have your transplant. To locate a transplant center near you, ask your doctor or contact the United Network for Organ Sharing by going online at www.unos.org or calling 1-888-894-6361.
• Schedule an appointment for an evaluation at the transplant center to find out if you are a good candidate for a transplant. Your transplant center can do all of the required tests, or your doctor can order the tests and send the results to the center.

During your evaluation, learn as much as you can about the transplant center. Find out whether the center will accept your insurance, what your options are if you don't have insurance, and whether support groups are available.

The transplant center will notify you within 2 weeks of your evaluation to let you know whether you have been placed on the waiting list. If you have questions about your list status, contact the transplant center where you were evaluated.

It may be days, months, or even years before you receive a new organ. When an organ is found, your transplant team will consider whether the donor is a good match for you, the status of your current health, and how long you've been on the waiting list. Your team will also consider the location of the donated organ, because it must be transplanted quickly to remain in working order.

Thinking about and waiting for a transplant can affect you emotionally. You may find it helpful to see a psychiatrist, psychologist, or a licensed mental health counselor about your transplant.

What tests will you need before your transplant?

Tests that are done for all organ transplant candidates include:

• A cross-match for transplant. This blood test shows whether your body will reject the donor organ immediately. It will mix a donor's blood with your blood to see whether your antibodies attack the antigens of the donor.
• Antibody screen. A panel-reactive antibody (PRA) test measures whether you have antibodies against a broad range of people. If you do, it means you are at higher risk of having rejection, even if the cross-match shows that you and the donor are a good match.
• Blood type .This blood test shows which type of blood you have. Your blood type should be compatible with the organ donor's blood type. But sometimes it's possible to transplant an organ from a donor with a different blood type.
• Tissue type .This blood test shows the genetic makeup of your body's cells. We inherit three different kinds of genetic markers from our mothers and three from our fathers. Tissue type sometimes plays a role in matching an organ recipient to a donor.
• A mental health assessment . This test identifies any psychological issues that may prevent you from receiving and caring for your new organ. A living donor may also be required to have this test before donating an organ.

The results of these medical tests will be used to match you with an organ donor. The more matches you have, the more likely your body will accept the new organ.

What if you're not a good candidate for an organ transplant?

You may not be a good candidate if you have an active infection, unstable heart disease, or another serious medical problem. Also, you will not be considered for organ transplant if you have a problem with alcohol or drugs.

If you are told that you are not a good candidate for organ transplant, find out if there are other treatments for your condition. Many people can live for years with serious health conditions.

The goal of your care may shift to maintaining your comfort. Talk to your loved ones about the type of care you would like to receive. Discuss their expectations as well as your wishes, care needs, and finances and the needs of your family. Your choices may change as your illness changes.

How successful are transplants?

Organ transplant success depends on:

• Which organ is transplanted.
• How many organs are transplanted. For example, you could have a heart transplant or a heart and lung transplant.
• The disease that has caused your organ to fail.
• The age of the donor organ. In general, the younger the organ donor, the healthier the tissue. But recent research is challenging this thought. It may be that some older organs work just as well as younger organs.
• The length of time that the donor organ is out of the donor's body. The more quickly an organ is transplanted after it is removed from the donor, the more likely that the transplant will be successful.
• How well the organ was preserved just before transplantation. The donor organ must be properly preserved while it is being transferred, especially if it was transferred from a long distance.

Here are the chances of being alive 5 years after having an organ transplant. These numbers are averages. Your personal chances will depend on your health, the donor organ, and other things.^{footnote 1}

• Heart: About 8 out of 10 people
• Intestine: About 6 out of 10 people
• Kidney: About 9 out of 10 people
• Kidney and pancreas: About 9 out of 10 people
• Liver: About 8 out of 10 people
• Lung: About 6 out of 10 people
• Pancreas: About 8 out of 10 people

Organ rejection is possible. When a new organ is placed into your body, your immune system sees it as foreign and tries to destroy it. Antirejection medicines can help prevent your immune system from attacking the donor organ.

You may worry about organ rejection or that your surgery will not be successful for another reason. These thoughts are normal. Many people write an advance directive and choose a health care agent when they are waiting for a transplant.

• Writing an Advance Directive
• Choosing a Health Care Agent

How can you get ready?

While you are waiting for your organ transplant, you will be given a pager or cell phone so the transplant center can contact you to tell you an organ is available. You may also wish to give the transplant center several numbers where you can be reached and the name and number of a few people who will always know how to reach you.

Arrange in advance for someone to go with you to the transplant center. This person can support you, listen to your doctor, and help you remember important instructions. This person can also report any change in behaviors or symptoms that you may have either before or shortly after the transplant.

Have your suitcase packed with the things you need to take with you to the transplant center. Your support person should also have a bag packed and ready to go.

At the Hospital

When you arrive at the hospital or transplant center because a donor organ has been found, you will immediately be prepared for surgery. Final tests will be done to make sure the donor organ is one that will likely work for you.

• If your doctors feel that a transplant with this organ has a good chance of being successful, you will have transplant surgery right away.
• If your doctors decide that a transplant with this organ does not have a good chance of being successful, the organ will be given to a person who is a better match, and you will return home and continue to wait for your new organ.

If your current health condition requires that you be hospitalized while you wait for a donor organ, you will receive supportive and lifesaving care (such as blood pressure support for heart failure) until you are matched with a donor organ. During that time, you will be given medicines to prepare you for the surgery and to prevent rejection.

After your transplant, the amount of time you'll spend in the hospital depends on how healthy you are before the surgery, which organ was transplanted, and how well your body accepts the donated organ.

A longer hospital stay may be needed for a heart or lung transplant than for a kidney transplant. Some people are out of the hospital within a few days after their transplant. Others may need to stay for a few weeks.

After the Transplant

Why does organ rejection happen?

Your immune system protects you from infection and disease. It defends your body by producing antibodies and "killer" cells that destroy foreign substances (such as viruses and bacteria). Since the donor organ doesn't match your own tissue exactly, your body tries to destroy the transplanted organ by rejecting it.

How can you prevent organ rejection?

Because your immune system will try to destroy the new organ, you will need to take antirejection medicines, or immunosuppressants, for as long as you have the donor organ.

These medicines weaken your immune system and decrease your body's ability to fight infections, cancer, and other diseases. You will have to stay away from large crowds for a while and from people who have infections.

It may help to talk to someone who has had a transplant. This person can talk to you about how you can make taking antirejection medicines part of your daily life. You will probably need fewer of these medicines over time. You may also need other medicines to fight infection or other health problems related to your transplant.

How will you feel after the transplant?

Almost immediately after a transplant, many people report feeling better than they have in years. The physical limitations you have will depend on the type of transplant you had, other conditions you may have, and whether your body rejects the donor organ. You will likely not face major physical limitations after you have healed from your transplant.

You may also have side effects from your antirejection medicines, and you may be at increased risk for getting conditions such as diabetes.

An organ transplant may cause many emotional issues both for you and those who care about you. When your organ comes from a deceased donor, you may sometimes think about that and what that meant to the donor's family.

It is common to have some depression after an organ transplant, although not everyone does. If you think you may be depressed, it is important to tell your transplant coordinator, doctor, or someone who cares about you. The earlier depression is treated, the more quickly you will recover and the better you will feel.

Staying Healthy

Preventing organ rejection

To keep your new organ healthy and to help you live longer after an organ transplant:

• Keep your doctor appointments. Regular follow-up with your doctor is important to check for organ rejection.
• Get regular blood and tissue tests so your doctor knows whether the new organ is accepted or rejected. Rejection doesn't mean that you will lose the new organ. Adding or changing medicines may still prevent rejection.
• Take your medicines exactly as prescribed . Talk with your doctor to make sure you understand what to do if you miss a dose.
• Don't take any nonprescription medicines, such as cold remedies or herbal remedies, before talking with your doctor. Other medicines may interact poorly with your antirejection medicines.
• Know the side effects of the antirejection medicines. If you have severe side effects, tell your doctor right away.

Taking steps to stay healthy

To help you and your new organ stay healthy:

• Get regular exercise. Activities like walking, exercises in the water, and yoga can help you keep your body and new organ healthy.
  • Fitness: Walking for Wellness
• Eat regular, healthy meals to control your weight, blood pressure, cholesterol, and blood sugar levels. Be sure to get plenty of calcium and vitamin D to help prevent osteoporosis, or thinning bones.
• Watch for changes from how you normally feel, how much energy you have, and how active you are. This can help you identify new problems as they come up.
• Tell your dentist that you have had an organ transplant. The antirejection medicines may increase your risk of mouth infections. Special precautions may be needed in teeth cleaning or other dental work.
• Stay away from people who are sick. Your immune system is weakened by the antirejection drugs. Before you do any traveling, talk with your doctor to see if you need to take any precautions.
• Carry a medical identification card or wear a medical ID bracelet that states that you have had an organ transplant.

Becoming an Organ Donor

Donor organs are needed-there are currently more than 100,000 people on the national organ transplant waiting list. If you are interested in donating an organ, contact the United Network for Organ Sharing (UNOS) at 1-888-894-6361 or go online at www.unos.org to get more information and to locate the nearest transplant center.

You can donate an organ upon your death, or in some cases while you are alive. To learn more, see the topics:

• Planning to Be an Organ Donor
• Living Organ Donation

Internet donor-matching services are set up to help people who need an organ transplant to contact potential living donors. Some experts believe these services undermine the current system, which is based on donated organs going to people who are most in need and those waiting the longest for a donor. Others believe online donor matching services provide a useful resource for helping people who have had problems finding a donor within the current system. For more information about these services, talk to your doctor.

You do not have to be a blood relative (such as a sibling or parent) of the person who receives your organ. You can be someone who is emotionally related to the person, such as a close friend or spouse, or you can even be a stranger.